脑电双频指数监测下瑞马唑仑在老年患者无痛胃肠镜检查中的剂量

Dose of remimazolam in painless gastroenteroscopy in elderly patients under bispectral index monitoring

目的探讨在老年患者无痛胃肠镜检查中,脑电双频指数(BIS)监测下应用瑞马唑仑的适宜初始剂量。方法选取2022年8月至11月于临沂市中医医院行无痛胃肠检查的165例老年患者,按照随机数字表法分为A、B、C三组,各55例。所有患者先静脉注射瑞芬太尼0.30μg/kg,A、B、C三组瑞马唑仑的初始剂量分别为0.15 mg/kg、0.20 mg/kg、0.25 mg/kg。当BIS<75或改良警觉/镇静评分(MOAA/S)<3分时,开始置入胃镜,肠镜开始前追加瑞芬太尼0.20μg/kg。记录三组入镜时间、首次追加瑞马唑仑间隔时间、胃肠镜检查总时间、胃肠镜检查瑞马唑仑总剂量、苏醒时间、离开复苏室(离室)时间,记录患者给药前(T0)、胃镜置入即刻(T1)、首次追加瑞马唑仑时(T2)、胃镜结束时(T3)、肠镜结束时(T4)时的脉搏血氧饱和度(SpO_(2))、心率(HR)、平均动脉压(MAP)、BIS值,观察麻醉期间及术后不良反应。结果与A组比较,B组、C组入镜时间缩短(P<0.05),首次追加间隔时间延长(P<0.05),胃肠镜检查瑞马唑仑总剂量增加(P<0.05),苏醒时间延长(P<0.05);C组离室时间延长(P<0.05)。与B组比较,C组胃肠镜检查瑞马唑仑总剂量增加,离室时间延长(P<0.05)。三组中,与T0时比较,T1时HR均增快,T1~T4时BIS和MAP降低(P<0.05);与A组比较,C组T1时BIS值降低(P<0.05);三组相同时刻的SpO_(2)、HR和MAP差异无统计学意义(P>0.05)。B组、C组体动或呛咳发生率降低(P<0.05),C组低氧血症发生率升高(P<0.05)。结论BIS监测下,在老年患者无痛胃肠镜检查中,应用瑞马唑仑初始剂量0.20 mg/kg镇静效果佳,入镜时间较短,首次追加间隔时间较长,离室早,对呼吸循环影响小,不良反应少。

Objective To explore the appropriate initial dose of remimazolam for painless gastroenteroscopy in elderly patients based on bispectral index(BIS)monitoring.Methods A total of 165 elderly patients who underwent painless gastroenteroscopy at Linyi Traditional Chinese Medical Hospital from August to November 2022 were randomly divided into three groups:group A,group B,and group C,with 55 patients in each group.All the patients received intravenous injection of remifentanil 0.30μg/kg at first.The initial dose of remimazolam in group A,B and C were 0.15 mg/kg,0.20 mg/kg and 0.25 mg/kg,respectively.When the BIS<75 or the modified observer s assessment of alert/sedation score(MOAA/S)<3,gastroscopy was placed.Remifentanil 0.20μg/kg was added before colonoscopy.The endoscopy insertion time,interval time of first additional remimazolam,total time for gastroenteroscopy examination,total dosage of remimazolam for gastroenteroscopy examination,awakening time,and discharge time from recovery room in three groups were recorded.The following patients indexes[including pulse oxygen saturation(SpO_(2)),heart rate(HR),mean arterial pressure(MAP),BIS values]were recorded at five timepoints[before medication administration(T0),immediately after gastroscopy insertion(T1),the time of first additional remimazolam(T2),the end of gastroscopy(T3),and the end of colonoscopy(T4)],as well as the adverse reactions were observed during anesthesia and after surgery.Results Compared with group A,in group B and group C,the gastroscopy insertion time shortened(P<0.05),the interval time of first additional remimazolam prolonged(P<0.05)and the total remimazolam dosage increased(P<0.05),the awakening time prolonged(P<0.05),and in group C discharge time from recovery room prolonged(P<0.05).Compared with group B,the total remimazolam dosage for gastroenteroscopy increased and discharge time from recovery room prolonged in group C(P<0.05).In the three groups,compared with T0,HR increased at T1,BIS value and MAP decreased at T1-T4(P<0.05);Compared with group A,the BIS value of group C decreased at T1(P<0.05).There was no significant difference in SpO_(2)、HR and MAP among the three groups at the same time(P>0.05).The incidence of body movement or cough in groups B and C decreased(P<0.05),and the incidence of hypoxemia in group C increased(P<0.05).Conclusion Under BIS monitoring,in elderly patients with painless gastroenteroscopy,remimazolam initial dose of 0.20 mg/kg has a better sedative effect,shorter endoscopy insertion time,longer interval for the first additional remimazolam,earlier departure from the recovery room,less impact on respiratory and circulation,and fewer adverse reactions.